scholarly journals Transparency, health equity, and strategies in state-based protocols for remdesivir allocation and use

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257648
Author(s):  
Zippora Kiptanui ◽  
Sanchari Ghosh ◽  
Sabeen Ali ◽  
Karishma Desai ◽  
Ilene Harris
Keyword(s):  
Health Disparities ◽  
Critical Role ◽  
District Of Columbia ◽  
Health Department ◽  
State Governments ◽  
Clinical Use ◽  
Allocation Strategy ◽  
Equitable Access ◽  
Health Policymaking ◽  
Allocation Strategies

Background The Emergency Use Authorization (EUA) of remdesivir for coronavirus disease 2019 raised questions on transparency of applied strategy, and how to equitably allocate and prioritize eligible patients given limited supply of the medication. The absence of federal oversight highlighted the critical role by states in health policymaking during a pandemic. Objective To identify public state-based protocols for remdesivir allocation and clinical guidance for prioritizing remdesivir use and assess approaches and inclusion of language promoting equitable access or mitigating health disparities. Methods We identified remdesivir allocation strategies and clinical use guidelines for all 50 states in the U.S. and the District of Columbia accessible on state health department websites or via internet searches. Public protocols dated between May 1, 2020 and September 30, 2020 were included in the study. We reviewed strategies for allocation and clinical use, including whether protocols contained explicit language on equitable access to remdesivir or mitigating health disparities. Results A total of 38 states had a remdesivir allocation strategy, with 33 states (87%) making these public. States used diverse allocation strategies, and only 10 (30%) of the 33 states included language on equitable allocation. A total of 30 states had remdesivir clinical use guidelines, where all were publicly accessible. All guidelines referenced recommendations by federal agencies but varied in their presentation format. Of the 30 states, 12 (40%) had guidelines that included language on equitable use. Neither an allocation strategy or clinical use guideline were identified (public or non-public) for 10 states and the District of Columbia during the study period. Conclusions The experience with the remdesivir EUA presents an opportunity for federal and state governments to develop transparent protocols promoting fair and equal access to treatments for future pandemics.

scholarly journals Immunoepigenetics Combination Therapies: An Overview of the Role of HDACs in Cancer Immunotherapy

2019 ◽  
Vol 20 (9) ◽  
pp. 2241 ◽  
Author(s):  
Debarati Banik ◽  
Sara Moufarrij ◽  
Alejandro Villagra
Keyword(s):  
Histone Deacetylase Inhibitors ◽  
Critical Role ◽  
Preclinical Studies ◽  
Clinical Use ◽  
Combination Therapies ◽  
Drug Candidates ◽  
Cellular Processes ◽  
Fda Approval

Long-standing efforts to identify the multifaceted roles of histone deacetylase inhibitors (HDACis) have positioned these agents as promising drug candidates in combatting cancer, autoimmune, neurodegenerative, and infectious diseases. The same has also encouraged the evaluation of multiple HDACi candidates in preclinical studies in cancer and other diseases as well as the FDA-approval towards clinical use for specific agents. In this review, we have discussed how the efficacy of immunotherapy can be leveraged by combining it with HDACis. We have also included a brief overview of the classification of HDACis as well as their various roles in physiological and pathophysiological scenarios to target key cellular processes promoting the initiation, establishment, and progression of cancer. Given the critical role of the tumor microenvironment (TME) towards the outcome of anticancer therapies, we have also discussed the effect of HDACis on different components of the TME. We then have gradually progressed into examples of specific pan-HDACis, class I HDACi, and selective HDACis that either have been incorporated into clinical trials or show promising preclinical effects for future consideration. Finally, we have included examples of ongoing trials for each of the above categories of HDACis as standalone agents or in combination with immunotherapeutic approaches.

Fragment Re-Allocation Strategy Based on Hypergraph for NoSQL Database Systems

2016 ◽  
Vol 8 (3) ◽  
pp. 1-23 ◽  
Author(s):  
Zhikun Chen ◽  
Shuqiang Yang ◽  
Yunfei Shang ◽  
Yong Liu ◽  
Feng Wang ◽  
...  
Keyword(s):  
Database Systems ◽  
Communication Cost ◽  
Allocation Strategy ◽  
Hypergraph Partitioning ◽  
Computing Model ◽  
Operation Pattern ◽  
Nosql Database ◽  
High Scalability ◽  
Weighted Hypergraph ◽  
Allocation Strategies

NoSQL database is famed for the characteristics of high scalability, high availability, and high fault-tolerance. It is used to manage data for a lot of applications. The computing model has been transferred to “computing close to data”. Therefore, the location of fragment directly affects system's performance. Every site's load dynamical changes because of the increasing data and the ever-changing operation pattern. So system has to re-allocate fragment to improve system's performance. The general fragment re-allocation strategies of NoSQL database scatter the related fragments as possible to improve the operations' parallel degree. But those fragments may interact with each other in some application's operations. So the high parallel degree of operation may increase system's communication cost such as data are transferred by network. In this paper, the authors propose a fragment re-allocation strategy based on hypergraph. This strategy uses a weighted hypergraph to represent the fragments' access pattern of operations. A hypergraph partitioning algorithm is used to cluster fragments in the strategy. This strategy can improve system's performance according to reducing the communication cost while guaranteeing the parallel degree of operations. Experimental results confirm that the strategy will effectively contribute in solving fragment re-allocation problem in specific application environment of NoSQL database system, and it can improve system's performance.

Community Hospital Disaster Preparedness in the United States

2018 ◽  
Vol 1 (2) ◽  
pp. 1-22
Author(s):  
Dan J. Vick ◽  
Asa B. Wilson ◽  
Michael Fisher ◽  
Carrie Roseamelia
Keyword(s):  
United States ◽  
Disaster Preparedness ◽  
Community Hospital ◽  
Critical Role ◽  
The United States ◽  
State Governments ◽  
Review Of The Literature ◽  
Community Hospitals ◽  
Current State ◽  
Hospital Disaster Preparedness

Disasters are common events in the United States. They generally result in casualties and community hospitals play a critical role in caring for these victims. Therefore, it is critical that hospitals are prepared for disasters. There has been increased focus on hospital disaster preparedness in the United States because of events that have occurred in the 21st century. To determine the current state of disaster preparedness among community hospitals, a comprehensive review of the literature was conducted that focused on studies and other articles pertaining to disaster preparedness in U.S. community hospitals. The review showed mixed results as to whether hospitals are better prepared to handle disasters. Barriers to preparedness were identified. Opportunities for improvement may require additional study and involvement by federal and state governments, other agencies, and hospitals themselves to overcome barriers and assist hospitals in achieving a higher level of preparedness.

scholarly journals Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ruoding Shi ◽  
Susan Meacham ◽  
George C. Davis ◽  
Wen You ◽  
Yu Sun ◽  
...  
Keyword(s):  
Health Disparities ◽  
Health Insurance ◽  
Coal Mining ◽  
Mortality Risk ◽  
Critical Role ◽  
Vital Statistics ◽  
Health Access ◽  
Knowledge Gap ◽  
County Level ◽  
Cross Sectional

Abstract Background Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as “coal-county effect.” We also investigated what factors may accentuate or attenuate the coal-county effect. Methods An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented. Results The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed. Conclusions This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.

Towards a Theory of Taxation

1984 ◽  
Vol 2 (1) ◽  
pp. 161-173
Author(s):  
J. R. Lucas
Keyword(s):  
United States ◽  
New York ◽  
Federal Government ◽  
Multinational Corporations ◽  
District Of Columbia ◽  
The United States ◽  
The State ◽  
State Governments ◽  
The Cost ◽  
George Iii

“Towards a Theory of Taxation” is a proper theme for an Englishman to take when giving a paper in America. After all it was from the absence of such a theory that the United States derived its existence. The Colonists felt strongly that there should be no taxation without representation, and George III was unable to explain to them convincingly why they should contribute to the cost of their defense. Since that time, understanding has not advanced much. In Britain we still maintain the fiction that taxes are a voluntary gift to the Crown, and taxing statutes are given the Royal Assent with the special formula, “La Reine remercie ses bons sujets, accepte leur benevolence, et ainsi le veult” instead of the simple “La Reine le veult,” and in the United States taxes have regularly been levied on residents of the District of Columbia who until recently had no representation in Congress, and by the State of New York on those who worked but did not reside in the State, and so did not have a vote. Taxes are regularly levied, in America as elsewhere, on those who have no say on whether they should be levied or how they should be spent. I am taxed by the Federal Government on my American earnings and by state governments on my American spending, but I should be hard put to it to make out that it was unjust. Florida is wondering whether to follow California in taxing multinational corporations on their world-wide earnings.

scholarly journals Combatting the opioid epidemic: Baltimore’s experience and lessons learned

2017 ◽  
Vol 40 (2) ◽  
pp. e107-e111 ◽  
Author(s):  
Leana S Wen ◽  
Katherine E Warren
Keyword(s):  
Critical Role ◽  
Health Department ◽  
Lessons Learned ◽  
Federal State ◽  
Opioid Epidemic ◽  
Baltimore City ◽  
Overdose Prevention ◽  
Opioid Crisis ◽  
Drug And Alcohol ◽  
The City

Abstract In the midst of a national opioid crisis, Baltimore City witnessed 393 deaths from drug and alcohol overdose in 2015. With an estimated 25 000 residents who are addicted to heroin or other opioids, Baltimore has been profoundly affected by the opioid epidemic. Other resources have commented on federal, state-based, and provider responses to the opioid crisis. This article examines what may be done at the city level based on the experiences of the Baltimore City Health Department. Local jurisdictions must play a critical role in addressing the U.S. opioid crisis through public health coalitions, overdose prevention, treatment expansion, and anti-stigma education.

The Political Economy of Religion and Social Insurance in the United States, 1910–1939

2006 ◽  
Vol 20 (2) ◽  
pp. 132-159 ◽  
Author(s):  
Kenneth Scheve ◽  
David Stasavage
Keyword(s):  
United States ◽  
Political Economy ◽  
Social Insurance ◽  
Critical Role ◽  
Income Redistribution ◽  
The United States ◽  
Policy Outcomes ◽  
The Political ◽  
State Governments ◽  
Individual Preferences

There are few scholars who would disagree with the proposition that individual economic position and economic risk play a critical role in shaping preferences for income redistribution and social insurance. There is less consensus, however, about the extent to which non-economic factors also influence individual preferences regarding social insurance provision. A number of scholars have examined how issues of race and identity have influenced the development of social insurance programs in the United States, as well as individual attitudes with respect to these programs. In a theoretical context, other authors have considered how attitudes toward income redistribution might also depend upon psychological dispositions such as the “belief in a just world.” In this article, we focus on religiosity as an important factor that can shape both individual preferences and policy outcomes regarding social insurance in the United States. To do so, we develop an argument about religion and social insurance as substitutes that draws both on existing work on the political economy of social insurance and on findings in social psychology regarding what we call the “coping effect” of religion. We test our hypothesis using historical evidence from two early social insurance policies: workers’ compensation legislation enacted by state governments between 1910 and 1930 and New Deal unemployment relief.

scholarly journals Identifying Areas with Disproportionate Local Health Department Services Relative to Opioid Overdose, HIV and Hepatitis C Diagnosis Rates: A Study of Rural Illinois

2019 ◽  
Vol 16 (6) ◽  
pp. 989 ◽  
Author(s):  
Colleen McLuckie ◽  
Mai Pho ◽  
Kaitlin Ellis ◽  
Livia Navon ◽  
Kelly Walblay ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Disease Burden ◽  
Hiv Transmission ◽  
Critical Role ◽  
Health Department ◽  
Opioid Overdose ◽  
Local Health ◽  
Opioid Use ◽  
Related Services ◽  
Rural Counties

Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings. Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden.

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